Life Care Planning: A Comprehensive Approach to Elder Law – Q3 2024 Facts & Findings
In early 2022, Chris found himself in a difficult position. His mother, Marie, was having significant health problems. Marie was showing some of the classic signs of dementia. She was irritable, forgetful, and uncooperative. To make matters worse, Chris was her only child and lived in Canada, while Marie lived alone in her home in South Carolina. Marie’s doctors were starting to say that Marie could not stay home alone for much longer.
Marie and Chris were encountering some of the most common, yet difficult to navigate, problems that folks run into along the aging continuum.
Where would Marie live once she could no longer live on her own? What facilities are actually good places to live? How would Marie pay for a new place? Would Marie leave her home voluntarily? Would Marie qualify for any government benefits? What if Marie has too much money to qualify for the benefits she needs? How would Marie maximize her government benefits? When and how could Chris make decisions and manage Marie’s affairs for her?
Elder law refers to law practice focused on issues commonly faced by our elders, including asset protection, estate planning, guardianships and conservatorships, probate, and disability planning. Elder law attorneys are well-versed in advising clients and their families on the legal implications of various financial strategies. Elder law attorneys know the Medicaid Policy and Procedures Manual like the back of their hand and can advise on various Medicaid options, from a spend down to half a loaf to a 5-year irrevocable lookback trust. However, many elder law attorneys’ advice stops at the conference room table. That is unless they subscribe to the Life Care Planning model.
Traditionally, elder law attorneys have advised on the elder law aspects of aging, prepared the supportive legal documents, and sent clients on their way to navigate the practical difficulties that go together with such planning. Enter Life Care Planning (LCP). This dynamic approach to elder law is a holistic and cooperative take on navigating aging issues.
Life Care Planning is the process of addressing financial, legal, and care needs for an aging person. LCP is a collaborative, ongoing process that involves attorneys and non-attorney liaisons referred to as Elder Care Coordinators (ECCs). An ECC is an elder-focused professional with experience in social work, nursing home administration, or nursing. The LCP engagement is not based on a single transaction. It is an ongoing relationship that lasts for a specified period, usually in one-year engagements. The goal of LCP is to support aging individuals, couples, and their families by creating legal, financial, and care plans that flex proactively as circumstances change over time.
FROM HOME TO ASSISTED LIVING
For Chris and Marie, giving them some legal advice and a few documents before sending them along would address almost none of their biggest concerns. They may have a plan to preserve some assets, but the practical questions about where to go and how to get there are not answered by legal documents and an instruction sheet. LCP can provide the support they really need.
The first issue to address is one that we see time and time again in the elder law arena: capacity. Capacity evaluations are done by both the attorney and ECC. The ECC’s evaluation is normally completed at the individual’s residence, which can be less stressful than a visit to the attorney’s office and, therefore, increase the accuracy. In Chris and Marie’s situation, the attorney and ECC determined that Marie had capacity to sign legal documents, and she signed the right financial power of attorney to ensure that Chris would be able to act for her in managing finances and protecting assets.
Perhaps the biggest hurdle for Chris was getting Marie to understand that she would be safer and happier in assisted living. Marie was isolated at home and struggling to care for herself and her house. The ECC met with Marie and established a relationship with her. She identified what was important to Marie in deciding where to live. Initially, Marie was resistant to discussions about moving to an assisted living community. However, the ECC was able to gain Marie’s trust by building a relationship with her and taking the time to listen to her concerns. Suggestions made by a caring professional are often better received than those made by a family member. Children often make similar suggestions and hit a wall, but when the ECC works through the options, the elder tends to be more receptive.
The ECC then compiled a list of facilities that would be appropriate for Marie in terms of cost, her care needs, and location. The ECC coordinated with the facilities to get detailed pricing and determine whether Marie was a good fit for the community. The burden on Chris was greatly reduced as now all he had to do was help choose an assisted living community from the pre-vetted list.
The ECC facilitated communication with the assisted living community and helped organize the move. Unfortunately, placement did not turn out to be that simple. These practical matters would have been incredibly difficult for Chris to manage from his home in Canada, and addressing them would have been nearly impossible without the collaboration of the ECC. Once Marie arrived at the assisted living community, she became upset and confused and was ultimately not admitted to the community and instead taken to a local hospital.
The ECC hit the ground running again and identified another community. Usually, finding placement for someone who was turned away at one assisted living community is very difficult, and it may not have been possible for Chris to find placement for Marie without the help of someone well-versed in assisted living community options. The ECC was able to vouch for Marie and get her admitted to the second community.
Of course, finding an assisted living community was just half the battle. Marie could not stay in her new community for very long unless she found a way to pay for her stay.
Since LCP is an ongoing relationship and not a single transaction, the ECC continued to support Marie’s needs. She helped identify a real estate agent to list Marie’s home for sale and helped Chris find a local company to clean out the house to prepare it for sale. The sale of the house gave Marie access to the funds she needed to pay for her care. Part of the plan for Marie included a long-term financial strategy to qualify for government benefits in the future as her care needs increase.
Today, Marie is cared for by staff in a facility personally vetted by an ECC with years of experience advocating for the elderly. Marie has developed friendships with other residents and feels a sense of community, and her health has improved since getting access to the care she needs. The ECC visits Marie periodically to make sure that she is getting the care she needs, and the visits help Chris feel better about the care his mother is receiving without having to make frequent trips to South Carolina. Marie is now in a significantly more stable situation financially, legally, mentally, and physically. The LCP collaboration in this area of the law can expand the positive impact law firms can have on the lives of people like Marie and Chris.
JOSEPH AND EMILY’S MEDICAID JOURNEY
Joseph called for help for his mother Emily. Emily had Parkinson’s disease and was living in Joseph’s home. Before meeting with us, Joseph and Emily worked together to sell her home, so she had excess funds that would have to be dealt with for her to qualify for Medicaid. Emily had declined to the point that Joseph could no longer meet her care needs himself. He needed help identifying acceptable home health-care agencies. After spending nights and weekends attempting to find an appropriate home health-care provider without success, Joseph became worried that the only option would be to move Emily to a facility.
Joseph and Emily were surprised to find out from us that Medicaid offers home- and community-based waiver services to help pay for home health care. The ECC coordinated with Joseph and Emily to get a level of care assessment for Emily from the South Carolina Medicaid agency and provided Joseph and Emily with a list of home health-care providers that fit their needs. After the level of care assessment confirmed that Emily medically qualified for Medicaid benefits, we started the process of dealing with her excess resources to get her qualified. This involved guiding Joseph and Emily through a half a loaf plan, a traditional tool utilized by elder law attorneys. Ultimately, our Medicaid Coordinator was able to get Emily qualified for Medicaid and preserve just over half of her assets in the process. Joseph was able to use the preserved assets to pay for additional care hours not covered by Medicaid. As a result, Emily was able to stay at home for as long as possible.
During this process, the ECC was preparing for the possibility that Emily would eventually need to go to a nursing home. Before placement was needed, the ECC, with the assistance of our Medicaid Coordinator, began reaching out to communities and came up with a list of options that were appropriate for Emily and would accept her Medicaid benefits. We were ready with a list of options for placement for the time when Emily could no longer stay at home. Eventually, Emily did decline, and Joseph was close to running out of the funds set aside to supplement the home health-care hours paid for by Medicaid. The transition from Joseph’s home to the nursing home was seamless, thanks to the proactive efforts of the ECC.
With the collaboration of non-legal professionals dedicated to geriatric care and compassion, elder law attorneys can now address the complex issues families face and provide a holistic and comprehensive plan that addresses more than just legal needs. Life Care Planning is helping South Carolina families who are navigating the maze of aging and long-term care.
If you are interested in learning more about how these services can be utilized to further assist your clients, more information is available at www.LawyerLisa.com.
*Names and details have been changed for this article.
Author Biographies:
Lisa Hostetler Brown is a certified elder law attorney and owner of LawyerLisa, LLC.
em: info@lawyerlisa.com
Thomas Hughes is an associate attorney at LawyerLisa, LLC. The team of attorneys, ECCs, Medicaid coordinators, and paralegals serve the entire state of South Carolina.
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